Experiences of COVID‐19 pandemic‐related stress among sexual and gender minority emerging adult migrants in the United States

Abstract There is a dearth of research that examines COVID‐19‐related stress among multiply marginalised individuals who are in the developmental phase of emerging adulthood. This qualitative study investigated how the intersection of emerging adulthood, sexual and gender minority (SGM) identity, and migrant status were reflected in the experiences of SGM individuals (n = 37; ages 20–25 years old) who migrated to various parts of the United States in the last 5 years. Data were collected online using semi‐structured interviews. Thematic analysis revealed that participants' developmental processes (e.g., identity exploration, building financial independence) were shaped by pandemic‐related stressors, especially unemployment and financial instability. Participants who were able to maintain employment did so but at the risk of their health and safety. Findings also showed that participants experienced feelings of anxiety and depression due to social isolation, but online communication played an important role in combatting loneliness. Findings highlight the potential for trauma‐informed and intersectional approaches to practice with SGM emerging adult migrants and expanded health services and temporary entitlement programs to mitigate the pandemic's effects on this population's psychosocial and financial well‐being.

. The SGM migrant population in the United States totals 1.25 million, accounting for 3% of all migrants and 6.25% of all SGM adults in the country (Goldberg & Conron, 2021;Human Rights Campaign Foundation, 2021). While many SGM migrants leave their countries of origin searching for safety and protection, they often continue to face interpersonal violence and social-structural inequalities in destination countries, including the United States (Alessi et al., 2021;Golembe et al., 2021). These vulnerabilities may be compounded by stressors common to various developmental phases. For instance, it has been estimated that 42% of the SGM migrant population in the United States are in their late teens to late twenties (Goldberg & Conron, 2021). For those 18-25 years old, this period is typically referred to as emerging adulthood (Arnett, 2000). Research on SGM emerging adult migrants has been scarce, especially during the COVID-19 pandemic, which has increased stress for marginalised groups (Kantameni, 2020). The pandemic-related research that is available tends to examine SGM emerging adults and migrants discretely. SGM emerging adults have experienced increased isolation during the COVID-19 pandemic due to the need for social distancing Scroggs et al., 2021). Some have also had to return to homes with unsupportive family members (Mitchell et al., 2022). Migrants have also encountered severe stressors during the pandemic, including housing insecurity, unemployment, and difficulty accessing healthcare when ill (Mengesha et al., 2022). Undocumented migrants have been seriously affected, as most were ineligible for government benefits to help sustain them through extended periods of unemployment (Clark et al., 2020). Thus, the current study seeks to fill a knowledge gap by understanding the intersectional experiences of pandemic-related stress among SGM emerging adult migrants. Results may guide service provision, programing, and policy to support SGM emerging adult migrants during public health crises.

| SEXUAL AND GENDER MINORITY EMERGING ADULTS
The paradigm of life course scholarship has gradually shifted to acknowledge a new pattern of development in industrialised societies (Arnett, 2000;Salvatore, 2018), since, instead of settling into longterm adult roles immediately, many individuals spend their late teens to mid-twenties amassing new experiences (Arnett, 2000;Salvatore, 2018). Emerging adulthood presents opportunities to explore identity and build independence, but its transitions can be destabilising, partially explaining why this stage confers vulnerability to psychopathology (Hunt & Eisenberg, 2010). Emerging adulthood has been an evolving concept, partly due to social and economic forces making it increasing difficult for young adults who must financially support themselves, without the assistance of family, to engage in exploration that is characteristic of this phase (Hendry & Kloep, 2010; Thomas & Azmitia, 2014). In fact, evidence suggests that emerging adults experience higher rates of poverty than other age groups (Hawkins, 2019).
The study of emerging adults as a monolith can obfuscate disparities faced by subgroups during this developmental stage. Specifically, SGM emerging adults are challenged by minority stress (Brooks, 1981;Hendricks & Testa, 2012;Meyer, 2003) due to exposure to the heterosexist and cissexist contours of everyday life (Wagaman et al., 2014). Minority stress theory (Meyer, 2003) postulates that health disparities between cisgender/heterosexual individuals and SGM individuals can be explained by the unique social stressors (e.g., discrimination and prejudice, expectations of stigma, internalising stigma, identity concealment) that the latter experience as a result of their minority status (Pachankis, 2007;Reisner et al., 2016). Minority stress has been linked with negative outcomes, like depression, substance use, suicidal ideation, and unwanted sexual experiences (Hunter et al., 2021;Mongelli et al., 2019;Murchison et al., 2017).
While SGM emerging adults are at risk for these negative outcomes, they also exhibit remarkable strength and resilience in the face of adversity (Russell, 2005). For example, SGM emerging adults have leveraged information and communication technologies (ICTs) to combat the effects of minority stress, using them to access information, find community support, and develop a sense of acceptance (McInroy et al., 2019). However, ICT use has also been associated with negative outcomes among SGM youth, including higher rates of victimisation and psychological distress (McConnell et al., 2017).

| INTERSECTIONALITY
While SGM emerging adults share similarities when it comes to their diverse sexual orientations and gender identities, their experiences are also shaped by systems and structures relating to race/ethnicity, class, ability, and immigration status (Moradi & Grzanka, 2017).
Emerging adults with intersecting identities (e.g., being a Black gay migrant) experience stigma and discrimination that is compounded by their minoritised and racialised identities. Thus, intersectionality (Crenshaw, 1989) allows for examination of how the interplay of various forms of identity reflect interlocking systems of oppression for multiply marginalised individuals. Grounded in and informed by the work of Black feminists and women-of-colour activists (Collins & Bilge, 2016), intersectionality underscores how distinct forms of oppression, which are deeply embedded in societal structures, shape the individual experiences of those holding more than one marginalised identity (Moradi & Grzanka, 2017).
Research on SGM migrants has used intersectionality to explain how stigma and discrimination related to their multiply minoritised identities can make it difficult to meet basic needs and access support from diaspora communities, who can be homophobic and transphobic, and SGM and mainstream communities, who can be racist, xenophobic, as well as homophobic and transphobic Lee & Brotman, 2013).

| COVID-19 AND ITS IMPACT ON MARGINALISED POPULATIONS
Intersectionality can appropriately contextualise the stressful experiences of SGM emerging adult migrants during the COVID-19 pandemic. The United States currently has the highest number of COVID-19 cases and related deaths in the world (Johns Hopkins Coronavirus Resource Center, 2022), and the pandemic has worsened inequalities among marginalised groups that were already disproportionately affected by systemic oppression (Kantameni, 2020). For instance, there is evidence that the pandemic exacerbated food insecurity (Russomanno & Tree, 2020) and financial hardship (Wilson et al., 2020) for SGM individuals. Additionally, SGM adults were at high risk for unemployment, with one in three employed in industries (e.g., restaurants, transportation) vulnerable to closure (Gonzales & de Mola, 2021). Higher rates of psychopathology have also been reported among SGM people during the pandemic (Kamal et al., 2021;Salerno et al., 2020). Closures of schools and recreational spaces increased time spent in abusive homes and decreased access to identity-based supports, which may have been contributing factors (Gato et al., 2021;Sachdeva et al., 2021). COVID-19-related barriers to health services also precluded the wellness of SGM individuals with intersectional identities; for example, disruption to HIV and behavioural health services may have compounded existing factors that contribute to HIV risk for Latinx sexual minority men (Harkness et al., 2022a).
However, the strengths of SGM individuals throughout the pandemic must be recognised. Studies have shown that SGM youth used online supports during COVID-19 to maintain social connections, helping them cope with adversity Gonzalez et al., 2021).
The pandemic has also exacerbated social-structural stressors for migrants, many of whom, like SGM adults, worked in COVID-19-sensitive industries and lost their jobs (Borjas & Cassidy, 2020). In leisure and hospitality, the April 2020 unemployment rate (39.3%) was the highest on record for the industry (U.S. Bureau of Labor Statistics, 2022). Existing policies also prevent migrants, especially undocumented migrants, from accessing healthcare or economic relief, leaving many without any formal social safety net (Mengesha et al., 2022). Meanwhile, working during the pandemic came with fears about possible exposure to COVID-19 (Sonmez et al., 2020)

| METHOD
This qualitative study was part of a larger study that explored how ICTs facilitated resettlement and integration for this population . Results of the larger study illuminated the role of ICTs across participants' migration trajectory. In this article, SGM migrant refers to SGM immigrants, refugees, or asylum seekers. Immigrants are those who move to a foreign country, permanently or for an extended period, including international students (IOM, 2022).
Despite having valid documentation, international students experience 'extended precarity,' as they must assess how to live and work in the destination country after their student visa expires (Chacko & Price, 2021). This precarity can be compounded for some SGM international students because returning to their country of origin means needing to once again conceal their identities to protect themselves against violence and abuse . Refugees and asylum seekers are those who flee from their country of origin to escape persecution, but refugees are vetted prior to arrival in a host country, while asylum seekers are vetted afterwards (United Nations High Commission for Refugees, 2021a, 2021b). There certainly are differences among these groups, but SGM migrants is used as they share similar vulnerabilities across the migration trajectory (Alessi et al., 2021;Lee, 2019).

| Participants and procedure
The sample comprised 37 SGM individuals between the ages of 20-25 (M = 23.27). Table 1 displays the sample's demographic information. We protected participants' privacy and thus did not ask which U.S. state they lived in, but, in some interviews, participants reported living in various geographic areas across the continental United States.
We recruited participants nationally using purposive sampling. A study announcement was emailed to community and social service agencies that provide socio-emotional and practical support to LGBTQ+ individuals or migrants in the United States. This announcement was also posted on social media (Facebook and Instagram) with a series of keywords, or hashtags (e.g., #lgbtq, #refugeeswelcome) to increase visibility. We also paid to advertise the study on Facebook for 1 week and allowed participants to refer others for participation. Facebook advertising has been used for ALESSI ET AL. Being a permanent resident is also referred to as having a Green Card. study recruitment (Akers & Gordon, 2018)  screening, but a procedure was created to refer individuals to resources as needed (McInroy, 2016). Those deemed eligible for study participation were asked to provide a pseudonym to maintain anonymity throughout the study process. All individuals were screened by the second author via telephone before each interview; 38 of 40 individuals who were screened ultimately met eligibility criteria.
Once interviews were scheduled, participants received a confirmation email with a copy of the informed consent document and were instructed to review it. This allowed participants ample time to familiarise themselves with the study and to ask any questions about participation (Newman et al., 2021). Interviewers reviewed the consent form with participants, allowed time to address questions or concerns, and obtained consent before data collection. The institutional review board of the first author's university approved all study procedures.

| Data collection
Data collection consisted of two stages: first, a short demographic questionnaire (age, country of origin, gender identity, sexual orientation, education level, immigration status, social media platforms used), followed by semi-structured interviews conducted via Zoom between October 2020 and March 2021. The use of Zoom as a viable method for conducting qualitative interviews is well documented (Archibald et al., 2019), and its use was vital for a national study.
Interviewers had their webcams on during the interviews, and while participants were invited to do the same, due to privacy concerns, low Internet bandwidth, or limited webcam functionality, 27 kept their webcams off. Eight participants had their webcams on, and three turned their webcams off in the middle of their interviews due to connectivity issues. One of those three interviews was not completed due to ongoing connectivity issues; thus, data from this participant was not analysed.  (Guest et al., 2020).
Because 13 participants had already been recruited before saturation, we still interviewed them. As a token of appreciation, participants received a $40 Amazon gift card after completing the interview. Interviews were audio-recorded and professionally transcribed.

| Data analysis
We analysed the data using Braun and Clarke's (2006) principles of thematic analysis. Thematic analysis is a flexible method of identifying and reporting patterns in qualitative data (Braun & Clarke, 2006). In this study, we used it as a realist and constructionist method, reporting on meanings and realities attached to participant experiences and the ways these meanings and realities are shaped by social forces (Braun & Clarke, 2006). Analysis began with the second author (SPC) familiarising themself with the data, including previous codes that were developed from the larger study ).
In the current study, codes were generated inductively (i.e., new codes were added to the codebook) and deductively (i.e., codes that were already identified, but not used as part of the larger study, were further explored to discern relevance to the current study's research questions). Examples of early codes include: COVID-19 and anxiety, uncertainty, loneliness, financial instability, employment concerns, and risks to health. Once coding was complete, the first and second authors (EA and SPC) engaged in peer debriefings to generate preliminary themes. This included returning to the dataset to confirm that themes answered the research questions and conveyed a cohesive narrative. Theme names were created and refined to ensure they captured participant experiences and the meanings attached to these experiences. Themes were not finalised until both the first and second authors reached mutual agreement.
During analysis, we (EA and SPC) acknowledged our own assumptions to ensure that participant experiences were not diluted.
We assumed that participants would experience challenges and subsequent distress as a result of the COVID-19 pandemic and that the impacts would be magnified by insecure immigration status or lack of support. After identifying our key assumptions, we discussed how our positionalities (that is, as LGBTQ+ individuals with secure immigration status) might shape the development of themes. We challenged one another to be reflexive, so our standpoints did not overshadow the analysis (Barusch et al., 2011). To ensure ALESSI ET AL.
-5 methodological rigour, we used negative case analysis to identify participants whose experiences were not consistent with the majority. We also engaged in member checking, emailing all participants a draft of the themes and asking whether the themes captured their experiences. Seven (18.9%) responded and confirmed findings aligned with their contributions. Further, we used an audit trail to document all processes and procedures.

| RESULTS
Participants reported they migrated to the United States for a combination of reasons (e.g., education, employment), with the majority stating that a primary factor was the need to live openly as

| Theme 1: 'It's very bad, very bad feeling:' Dealing with anxiety and uncertainty related to COVID-19 job loss and insecurity
For most participants, financial autonomy was required in order to live freely in United States. and before the pandemic they maintained this autonomy through steady employment in the service industry (hairstyling, cleaning, and providing transport). However, the pandemic brought precarity to the industry. 14 of the 32 participants (43.8%) who were employed pre-pandemic reported decreases in income during COVID-19, either due to work reduction or job loss.
This economic impact hurt their mental health, contributing to anxiety and uncertainty. Descriptive � Participants had no option but to continue working outside of the home at the onset of the pandemic, as they could not rely on their parents or others for financial support. � Not having much choice left participants uncomfortable about the risks they had to take to survive during a pandemic that the world did not know much about at the time, including how contagious or deadly it could be. � Participants took precautions to protect themselves (e.g., social distancing, wearing masks), but the people they worked with or for did not always follow health and safety protocols, leaving participants in danger of contracting COVID-19. Descriptive � The pandemic's consequences were far-reaching, going beyond the negative feelings that were brought on by work and financial strain. � COVID-19 quarantine left participants isolated; many had already experienced isolation in their countries of origin because of their sexual orientation or gender identity. � Participants reported intense loneliness, fear, and anxiety. � This was compounded for transgender and non-binary participants, who were dealing with gender dysphoria, preexisting mental health issues, and insecure immigration status. Descriptive � Despite the challenges participants faced during the pandemic, they found a way to be resourceful by using ICTs. This highlighted participants' strength during the pandemic. � ICTs (e.g.,WhatsApp, Facebook, Zoom) helped participants stay connected to other people during quarantine, which helped combat loneliness. � ICTs (e.g., dating apps) could also buffer against anxiety and depression by helping participants make new connections. � Participants reported a drawback to using ICTs during the pandemic; constantly reading about and hearing bad news heightened the anxiety of some.

Exemplar quotes
� It was very hard during the COVID to meet someone, even travelling because of the lockdown. It has been very difficult because you have no private vehicle. So I started using … the dating apps … at least for me to socialise and have friends… (Alan, a 24-year-old gay man). � We are able to not just support each other mentally, we kind of support each other financially sometimes. So one of us has a challenge…then we come together and collect and look for a way [to help] … we deal with collective issues that then regard each of us (Slayer, 24-year-old bisexual woman). � I felt like it was taking a toll on me so I kind of stopped looking at the news. It's kind of selfish, but I had to just shut it down for a little bit … (Ron, a 25-year-old gay man).

| Theme 3: 'It's just a very stressful time and there is no solution:' Contending with loneliness, fear, and anxiety during COVID-19
The pandemic's consequences for participants' mental health were farreaching, meaning they went beyond negative feelings associated with work and financial strain. Many reported that they were isolated because of their sexual orientation or gender identity in their countries of origin, and migrating to the United States was a way of connecting with individuals who could affirm their identities. However, COVID-19 quarantine left participants isolated again and dealing with intense loneliness, fear, and anxiety, and sometimes this was on top of other psychological issues that they had already been struggling with. -9 Juno, a 23-year-old queer non-binary participant, migrated from a country known for being welcoming of people with diverse sexual orientations and gender identities, but grew up in a small town as a queer person of colour, which was very isolating for them. The pandemic left them feeling isolated again. These feelings were occurring at the same time that Juno was not only dealing with gender dysphoria but also their optional practical training expiring Although Archie feared what would happen if they were to have to go to the hospital, John expressed anxiety about not being able to go to the hospital or seeking treatment if her mental health issues became worse or if they became physically sick. As a person without documentation, seeking treatment led to fears about what could happen if people found out she was undocumented: 'I've been, like scared, even to seek … healthcare services, everything. I'm scared like they will discover and maybe deport me. So mostly I've been laying low.' 'Laying low,' for John, meant being safe from deportation, but not necessarily being safe from the health effects of the pandemic.

| Theme 4: 'We would talk about how life is going…and motivate each other about daily life:' Using online communication to manage social isolation during COVID-19
Many pandemic-related stressors were severe, and this intensity was unexpected, even for migrants living a new country. Despite the challenges they faced, participants found a way to be resourceful by  (Harkness et al., 2021) and lowincome workers (Purkayastha et al., 2021) have experienced during the pandemic; however, the qualitative nature of this study provides additional context with which to understand the intersectional experiences of SGM emerging adult migrants. Most participants migrated to the United States to live more openly as individuals with diverse sexual orientations and gender identities. As emerging adults, many achieved financial autonomy pre-pandemic as they explored their identities. Some were even supporting their families in their countries of origin, but pandemic-related stressors forced them to rethink how they were going to survive. Many were scared, anxious, and uncertain, especially those who lost their jobs or significant income. Although most were employed pre-pandemic, participants who were undocumented reported being ineligible for government assistance. A few who were permanent residents mentioned that this was the case for them, too. Indeed, evidence suggests permanent residents who had not paid taxes using a social security number or had not been in the country for 5 years were ineligible for COVID-19 stimulus checks (Ibe, 2020 Gonzalez et al., 2021), and also underscores how SGM individual's intersectional identities provide them with opportunities for resilience by connecting with others who share similar experiences (Morgan et al., 2021). Many participants noted that using ICTs was integral to deal with social isolation and loneliness. This is essential for recently arrived SGM migrants since positive close relationships can facilitate positive adjustment (Campione- Barr et al., 2021). In this study, participants who connected with friends and tried to meet new people using ICTs shared that they felt supported, despite not being able to connect in-person.
Participants did mention a drawback to using ICTs, however. For a few, like Ron, social media constantly exposed them to news about current events, which could overwhelm them. This is consistent with a study by Harkness et al. (2022b), who found that COVID-19 media consumption, at times, was unhelpful and stressful for Latino sexual minority men. Thus, overall findings suggest that practitioners may integrate ICTs into treatment with SGM emerging adult migrants but also work with them to recognise how ICTs can compound existing stress.

| Limitations
The current study has limitations to consider. First, we did not recruit to be interviewed mentioned the promise of the vaccine for restoring normalcy, but these codes did not feature prominently, likely related to the time that the majority of data were collected. Finally, while we interviewed participants until saturation, our sample did not allow for thorough examination of differences among gay men, lesbian women, and bisexual men and women. Future research should oversample these subgroups to better understand their experiences during the pandemic.

| Implications for practice, policy, and service provision
The study has implications for practice. Findings indicate that mental health practitioners may serve a crucial role in supporting the wellbeing of SGM emerging adult migrants. Alessi and Kahn (2017) outlined a framework for practice with SGM asylum seekers, which can be adapted for SGM migrants in general. This practice framework involves a trauma-informed approach, including intersectional critical inquiry and praxis and understanding processes associated with minority stress, acculturation, and integration .
This provides a holistic understanding of SGM migrants' experiences, especially as they attempt to manage the challenges precipitated by a public health crisis. to live independently, these social-structural stressors can be compounded by stigma related to their identities .

| CONCLUSION
The findings of this study shed light on the stressful experiences of SGM emerging adult migrants during the COVID-19 pandemic.
Many contended with concerns about financial independence and security, which gave rise to fears about being able to cover living expenses, on top of increasing anxiety and sadness about public health protocols and social isolation. While emerging adulthood is theorised as a gradual transition into independence, many participants expressed that the precarity of their situations and the need to continue to work high-risk jobs during a public health crisis were predicated on the fact that they had no one else supporting them.
ICTs provided an avenue by which to connect with friends, or to access social support, but many still lacked material forms of support. It therefore remains essential that practitioners, policymakers, and researchers factor SGM emerging adult migrants' overlapping vulnerabilities into their understanding of how to better support them and to mitigate the compounding effects of public health crises on well-being.

CONFLICT OF INTEREST
The authors declare that there is no conflict of interest.

DATA AVAILABILITY STATEMENT
Due to the nature of this research, supporting data are not publicly available.